- Email: [email protected]
Collaboration: Working together or cooperating with the enemy?
ARTICLE IN PRESS European Journal of Oncology Nursing (2007) 11, 104–105
Available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/ejon
EDITORIAL
Collaboration: Working together or cooperating with the enemy? This issue of the journal publishes two very different papers reporting studies of fatigue in individuals having chemotherapy. One took a phenomenological approach to reveal personal descriptions of how fatigue manifested in 10 people and mediated the relationship between self and body (Wu and McSweeney, 2007). The other measured its intensity in 249 people over a 14-day period following administration of chemotherapy (Miller et al., 2007). Necessarily the two studies were conceived and conducted differently. In the latter, data were collected from three different countries (United Kingdom, Ireland and Denmark). This will have entailed a degree of collaboration, yet from the paper it is unclear how individuals across the sites contributed to the study beyond facilitating data collection. Although useful on its own to maximise sample size, collaboration has many sides and has the potential to challenge traditional disciplinary approaches to research with the ultimate goal of improving patient care and influencing clinical outcome. Collaboration within research has been lauded as the way forward (Girot et al., 2004). Kim (2006) suggests that it is an indicator of high quality research. As a model of research it provides new opportunities but also challenges. It has been variously defined by The Penguin Dictionary (Allen, 2004)—according to the context of use—as:
working together or with somebody else on a common project or a common aim;
cooperating with one’s enemy of one’s country. Collaboration has the potential to be rewarding, providing a sense of belonging to a larger community who share similar goals. Frequently collaboration in healthcare brings together teams of individuals—sometimes from different professional groups or countries—with specific, diverse and complementary talents (Thompson, 2006). Collaborators usually hold differing perspectives and aims for the research according to their professional group, knowledge and experience. These views can enrich how a research topic is conceived through discussion of perspectives and priorities. As a result, takenfor-granted assumptions are challenged as the team develops fresh perspectives (Freshwater et al., 2006). With careful planning, research is able to meet a number of 1462-3889/$ - see front matter & 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejon.2007.02.003
objectives with relevance across different professions and disciplines. Further, collaborators’ understanding of different research philosophies and methods contributes to the evolving research design. Pooling of research skills gives rise in many instances to creative and rigorous research methodology and methods. Additionally, through collecting data across different sites, a project can access larger and more representative samples, thereby enhancing generalisability of study findings (Schneider et al., 2001). This is important for nursing research where all too frequently quality of research and scope of findings are dogged by inability to recruit sufficient patient numbers, such as in the area of end-of-life care (Nuss et al., 2005). Much discussion around the value of collaboration refers to international groups of researchers. Arguments in favour of international collaboration are somewhat similar to those outlined above. However, additional benefit is derived from the possibility to explore cultural similarities and differences (Woodgate et al., 2005). The literature also refers repeatedly to the desirability and proven benefit of multiprofessional collaboration. For example, in paediatric oncology, multiprofessional collaboration in therapeutic research has been responsible for enormous improvements in outcomes (Reaman, 2004). The continuation of this progress would benefit from what Rosenfield (1992) refers to as transdisciplinary work, where researchers work using a shared conceptual framework, drawing together disciplinary-specific theories and approaches to address a mutual problem. However, it is interesting to note that little discussion addresses the benefits, or otherwise, of collaboration within profession but across specialty. We believe that there is much to be gained from this activity. The authors have experience of collaborating across the age continuum to study fatigue in adolescents during and following treatment for cancer (Edwards et al., 2003; Gibson et al., 2005; Ream et al., 2006). The research team brought experience of cancer care in childhood and adolescence (FG and colleagues within paediatric and adolescent nursing) and knowledge of cancer-related fatigue in adults and methods to study this (ER and colleagues within adult nursing). Collectively this provided the team detailed insight into both the symptom and target population, and led to much
ARTICLE IN PRESS EDITORIAL energetic discussion about the differences and similarities in the nature and impact of fatigue across the lifespan. This debate is important as although services for adolescents and adults must be configured differently to meet the specific needs of these groups, the cut-off between adolescence and adulthood (and associated referral to adult or childhood services) remains necessarily arbitrary. Inevitably some adolescents will receive their care from adult focused services. Others may have cancer treatment in a paediatric setting but later be referred to adult services to meet ongoing needs. This transition can be difficult as individuals adapt from one system of care to another. Effective transition to adult services is more likely where there is common understanding of, and continuity in, meeting their needs (While et al., 2004). Such understanding will come about through collaborative work that builds a common understanding of symptoms, including manifestation of fatigue, across transition from child to adulthood. Our research team has found our collaborative programme of research into cancer-related fatigue in adolescence both fulfilling and successful. This collaboration continues; we are currently submitting proposals to grant awarding bodies for funding in order to progress our programme of research into cancer-related fatigue. But it is interesting to note that there appear few other such collaborative research groups in cancer care working across the age continuum, i.e. across early stages of life—adolescence and adulthood—or latter stages—adulthood and old age. This would appear an opportunity currently being wasted. To conclude, it is foolhardy to suggest that collaboration is not without its challenges. It is probably more natural for people to wish to compete with others than work with them and share the glory (Thompson, 2006). However, it is clear that the research that most benefits patients is collaborative. It is time for cancer nurses to embrace the culture of collaboration fully and work with professionals within and outside their professional groups to address the needs of patients across the age continuum. It is imperative that collaboration is seen as an opportunity to cultivate rich and comprehensive evidence on which to base care rather than as cooperating with the enemy!
References Allen, R., 2004. The Penguin Dictionary. Penguin Group, London. Edwards, JL., Gibson, F., Richardson, A., Sepion, B., Ream, E., 2003. Fatigue in adolescents with and following a cancer diagnosis: developing an evidence for practice. European Journal of Cancer 39 (18), 2671–2680.
105 Freshwater, D., Sherwood, G., Drury, V., 2006. International research collaboration. Issues, benefits and challenges of the global network. Journal of Research in Nursing 11 (4), 295–303. Gibson, F., Mulhall, A., Richardson, A., Edwards, J., Ream, E., Sepion, B., 2005. A phenomenological study of fatigue in adolescents receiving treatment for cancer. Oncology Nursing Forum 32 (3), 651–660. Girot, E., Goodman, B., Ross, K., Latter, S., Jackson, D., 2004. Recognising the challenges of collaborative, multi-site research. NT Research 9 (6), 411–420. Kim, K., 2006. Measuring international research collaboration of peripheral countries: taking the context into consideration. Scientometrics 66 (2), 231–240. Miller, M., Maguire, R., Kearney, N., 2007. Patterns of fatigue during a course of chemotherapy: results from a multi-centre study. European Journal of Oncology Nursing 11 (2). Nuss, S.L., Hinds, P.S., LaFond, D.A., 2005. Collaborative clinical research on end-of-life care in pediatric oncology. Seminars in Oncology Nursing 21 (2), 125–134. Ream, E., Gibson, F., Edwards, J., Sepion, B., Mulhall, A., Richardson, A., 2006. Experience of fatigue in adolescents living with cancer. Cancer Nursing 29 (4), 317–326. Reaman, G.H., 2004. Pediatric cancer research from past successes through collaboration to future transdisciplinary research. Journal of Pediatric Oncology Nursing 21 (3), 123–127. Rosenfield, P.L., 1992. The potential of transdisciplinary research for sustaining and extending linkages between health and social care sciences. Social Science and Medicine 35 (11), 1342–1357. Schneider, S.M., Hinds, P.S., Pritchard, M., 2001. From single site to societal belief: the impact of pediatric oncology nursing research. Journal of Pediatric Oncology Nursing 18 (4), 164–170. Thompson, D., 2006. International collaboration and sharing lessons learned. Journal of Research in Nursing 11 (4), 285–287. While, A., Forbes, A., Ullman, R., Lewis, S., Mathes, L., Griffiths, P., 2004. Good practices that address continuity in transition from child to adult care: synthesis of the evidence. Child: Care, Health and Development 30 (5), 439–452. Woodgate, R., Clarke, J., Gibson, F., Hallstrom, I., Kline, N., Monterooso, L., von Essen, L., Wettergren, L., 2005. Development of an international pediatric oncology research network. Pediatric Blood and Cancer 45 (4), 400 (Abstract 0.067). Wu, H.S., McSweeney, M., 2007. Cancer-related fatigue: ‘It’s so much more than just being tired’. European Journal of Oncology Nursing 11 (2).
Emma Ream King’s College London, Florence Nightingale School of Nursing and Midwifery, London, UK E-mail address: [email protected]
Faith Gibson UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK E-mail address: [email protected]
Available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/ejon
EDITORIAL
Collaboration: Working together or cooperating with the enemy? This issue of the journal publishes two very different papers reporting studies of fatigue in individuals having chemotherapy. One took a phenomenological approach to reveal personal descriptions of how fatigue manifested in 10 people and mediated the relationship between self and body (Wu and McSweeney, 2007). The other measured its intensity in 249 people over a 14-day period following administration of chemotherapy (Miller et al., 2007). Necessarily the two studies were conceived and conducted differently. In the latter, data were collected from three different countries (United Kingdom, Ireland and Denmark). This will have entailed a degree of collaboration, yet from the paper it is unclear how individuals across the sites contributed to the study beyond facilitating data collection. Although useful on its own to maximise sample size, collaboration has many sides and has the potential to challenge traditional disciplinary approaches to research with the ultimate goal of improving patient care and influencing clinical outcome. Collaboration within research has been lauded as the way forward (Girot et al., 2004). Kim (2006) suggests that it is an indicator of high quality research. As a model of research it provides new opportunities but also challenges. It has been variously defined by The Penguin Dictionary (Allen, 2004)—according to the context of use—as:
working together or with somebody else on a common project or a common aim;
cooperating with one’s enemy of one’s country. Collaboration has the potential to be rewarding, providing a sense of belonging to a larger community who share similar goals. Frequently collaboration in healthcare brings together teams of individuals—sometimes from different professional groups or countries—with specific, diverse and complementary talents (Thompson, 2006). Collaborators usually hold differing perspectives and aims for the research according to their professional group, knowledge and experience. These views can enrich how a research topic is conceived through discussion of perspectives and priorities. As a result, takenfor-granted assumptions are challenged as the team develops fresh perspectives (Freshwater et al., 2006). With careful planning, research is able to meet a number of 1462-3889/$ - see front matter & 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejon.2007.02.003
objectives with relevance across different professions and disciplines. Further, collaborators’ understanding of different research philosophies and methods contributes to the evolving research design. Pooling of research skills gives rise in many instances to creative and rigorous research methodology and methods. Additionally, through collecting data across different sites, a project can access larger and more representative samples, thereby enhancing generalisability of study findings (Schneider et al., 2001). This is important for nursing research where all too frequently quality of research and scope of findings are dogged by inability to recruit sufficient patient numbers, such as in the area of end-of-life care (Nuss et al., 2005). Much discussion around the value of collaboration refers to international groups of researchers. Arguments in favour of international collaboration are somewhat similar to those outlined above. However, additional benefit is derived from the possibility to explore cultural similarities and differences (Woodgate et al., 2005). The literature also refers repeatedly to the desirability and proven benefit of multiprofessional collaboration. For example, in paediatric oncology, multiprofessional collaboration in therapeutic research has been responsible for enormous improvements in outcomes (Reaman, 2004). The continuation of this progress would benefit from what Rosenfield (1992) refers to as transdisciplinary work, where researchers work using a shared conceptual framework, drawing together disciplinary-specific theories and approaches to address a mutual problem. However, it is interesting to note that little discussion addresses the benefits, or otherwise, of collaboration within profession but across specialty. We believe that there is much to be gained from this activity. The authors have experience of collaborating across the age continuum to study fatigue in adolescents during and following treatment for cancer (Edwards et al., 2003; Gibson et al., 2005; Ream et al., 2006). The research team brought experience of cancer care in childhood and adolescence (FG and colleagues within paediatric and adolescent nursing) and knowledge of cancer-related fatigue in adults and methods to study this (ER and colleagues within adult nursing). Collectively this provided the team detailed insight into both the symptom and target population, and led to much
ARTICLE IN PRESS EDITORIAL energetic discussion about the differences and similarities in the nature and impact of fatigue across the lifespan. This debate is important as although services for adolescents and adults must be configured differently to meet the specific needs of these groups, the cut-off between adolescence and adulthood (and associated referral to adult or childhood services) remains necessarily arbitrary. Inevitably some adolescents will receive their care from adult focused services. Others may have cancer treatment in a paediatric setting but later be referred to adult services to meet ongoing needs. This transition can be difficult as individuals adapt from one system of care to another. Effective transition to adult services is more likely where there is common understanding of, and continuity in, meeting their needs (While et al., 2004). Such understanding will come about through collaborative work that builds a common understanding of symptoms, including manifestation of fatigue, across transition from child to adulthood. Our research team has found our collaborative programme of research into cancer-related fatigue in adolescence both fulfilling and successful. This collaboration continues; we are currently submitting proposals to grant awarding bodies for funding in order to progress our programme of research into cancer-related fatigue. But it is interesting to note that there appear few other such collaborative research groups in cancer care working across the age continuum, i.e. across early stages of life—adolescence and adulthood—or latter stages—adulthood and old age. This would appear an opportunity currently being wasted. To conclude, it is foolhardy to suggest that collaboration is not without its challenges. It is probably more natural for people to wish to compete with others than work with them and share the glory (Thompson, 2006). However, it is clear that the research that most benefits patients is collaborative. It is time for cancer nurses to embrace the culture of collaboration fully and work with professionals within and outside their professional groups to address the needs of patients across the age continuum. It is imperative that collaboration is seen as an opportunity to cultivate rich and comprehensive evidence on which to base care rather than as cooperating with the enemy!
References Allen, R., 2004. The Penguin Dictionary. Penguin Group, London. Edwards, JL., Gibson, F., Richardson, A., Sepion, B., Ream, E., 2003. Fatigue in adolescents with and following a cancer diagnosis: developing an evidence for practice. European Journal of Cancer 39 (18), 2671–2680.
105 Freshwater, D., Sherwood, G., Drury, V., 2006. International research collaboration. Issues, benefits and challenges of the global network. Journal of Research in Nursing 11 (4), 295–303. Gibson, F., Mulhall, A., Richardson, A., Edwards, J., Ream, E., Sepion, B., 2005. A phenomenological study of fatigue in adolescents receiving treatment for cancer. Oncology Nursing Forum 32 (3), 651–660. Girot, E., Goodman, B., Ross, K., Latter, S., Jackson, D., 2004. Recognising the challenges of collaborative, multi-site research. NT Research 9 (6), 411–420. Kim, K., 2006. Measuring international research collaboration of peripheral countries: taking the context into consideration. Scientometrics 66 (2), 231–240. Miller, M., Maguire, R., Kearney, N., 2007. Patterns of fatigue during a course of chemotherapy: results from a multi-centre study. European Journal of Oncology Nursing 11 (2). Nuss, S.L., Hinds, P.S., LaFond, D.A., 2005. Collaborative clinical research on end-of-life care in pediatric oncology. Seminars in Oncology Nursing 21 (2), 125–134. Ream, E., Gibson, F., Edwards, J., Sepion, B., Mulhall, A., Richardson, A., 2006. Experience of fatigue in adolescents living with cancer. Cancer Nursing 29 (4), 317–326. Reaman, G.H., 2004. Pediatric cancer research from past successes through collaboration to future transdisciplinary research. Journal of Pediatric Oncology Nursing 21 (3), 123–127. Rosenfield, P.L., 1992. The potential of transdisciplinary research for sustaining and extending linkages between health and social care sciences. Social Science and Medicine 35 (11), 1342–1357. Schneider, S.M., Hinds, P.S., Pritchard, M., 2001. From single site to societal belief: the impact of pediatric oncology nursing research. Journal of Pediatric Oncology Nursing 18 (4), 164–170. Thompson, D., 2006. International collaboration and sharing lessons learned. Journal of Research in Nursing 11 (4), 285–287. While, A., Forbes, A., Ullman, R., Lewis, S., Mathes, L., Griffiths, P., 2004. Good practices that address continuity in transition from child to adult care: synthesis of the evidence. Child: Care, Health and Development 30 (5), 439–452. Woodgate, R., Clarke, J., Gibson, F., Hallstrom, I., Kline, N., Monterooso, L., von Essen, L., Wettergren, L., 2005. Development of an international pediatric oncology research network. Pediatric Blood and Cancer 45 (4), 400 (Abstract 0.067). Wu, H.S., McSweeney, M., 2007. Cancer-related fatigue: ‘It’s so much more than just being tired’. European Journal of Oncology Nursing 11 (2).
Emma Ream King’s College London, Florence Nightingale School of Nursing and Midwifery, London, UK E-mail address: [email protected]
Faith Gibson UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK E-mail address: [email protected]